Neuroradiological findings in patients with ophthalmoparesis

Abstract

INTRODUCTION: Ophthalmoparesis (dysfunction in eye movements) can be due to damage to the supranuclear, internuclear (brainstem) pathways, the ocular motor nerves themselves or the neuromuscular junction and can be expressed clinically as binocular diplopia (double vision) which constitutes a common reason for consultation, both in outpatients and in the emergency department. At the onset of acute symptoms of ophthalmoparesis, an efficient neuroradiological evaluation is necessary to help differentiate between the different diagnoses, clinical course, and treatment options.

OBJETIVE: To describe the imaging findings in MRI of the brain in patients with ophthalmoparesis. Specify the diagnoses derived from each finding. Identify the most frequently affected cranial nerve. To determine if there is a relationship between the presence of extraocular symptoms and pathological results of brain MRI.

 MATERIAL AND METHODS: This is an observational, retrospective, analytical study that included patients between 16 and 90 years old who consulted between 2020 and 2023 due to diplopia and/or limitation in ocular mobility, or if it had been evidenced by the physical examination. neurological. The following variables were evaluated: age, sex, unilateral, combined ophthalmoparesis, conjugate gaze deviation, MRI result, etiological diagnosis, affected cranial nerve, anatomical location of the lesion, presence of extraocular symptoms. Statistical analysis: for qualitative variables, percentage and absolute measurements were calculated. For quantitative variables, measures of position and dispersion. To compare qualitative variables (presence of extraocular symptoms and pathological brain MRI), the Chi-square test was used. The level of significance was set at 0.05.

RESULTS: We included 62 patients, of whom 34 (54.8%) were females. The mean age (standard deviation) was 50.00 (18.37) years. The MRI was pathological in 40 (64.51%) cases. Ischemic lesions were the most frequent finding in 13 (20.97%) cases with the brain stem being the most frequent location in 6 (46.15%) cases. Intracranial hemorrhages represented the second pathological finding (N= 6; 9.67%). Other findings were: radiological signs of intracranial hypertension in 4 (6.45%) cases, demyelinating lesions in 3 (4.83%) cases, meningeal enhancement in 3 (4.83%) cases and mesencephalic atrophy in 2 (3.22%) cases. Metastatic

lesions in extraocular muscles, pineal cysts and glomus tumors showed an individual frequency of 1 (1.61%) case. The most frequently affected cranial nerve was the VI in 25 (40%) cases. Extra-ocular manifestations were present in in 40 (64.51%). Among patients who had extraocular manifestations, the MRI was pathological in 36 (90%) cases, compared to those who did not had extraocular manifestations of whom the MRI was pathological in in 4 (10%) cases; p < 0.001.

CONCLUSIONS: In this study, more than half of the patients with ophthalmoparesis presented findings on brain MRI. Although it was performed in a sample of young patients, the main etiology responsible for the neuro-imaging findings was stroke, a potentially fatal pathology. Given that the presence of extraocular symptoms was associated with abnormal findings on brain MRI, we suggest performing neuroimaging in all patients who consult for acute ophthalmoparesis accompanied by extraocular symptoms.